With increases in the proportion of population with obesity in recent years, perioperative management for patients with obesity is deemed to become more important in the realm of surgery. In addition to difficulty in performing an operation itself, obesity is often complicated with so-called metabolic syndrome such as arteriosclerosis, hypertension, and diabetes mellitus and has high possibilities of complications including post operative infection. Therefore, obesity is thought to be an important risk factor in operations. However, influences on surgical stress in patients having such a risk and the risk of post operative complications could not be converted previously into numbers. Adiponectin is known to show low levels in patients with multiple risk factor syndrome including patients with obesity. Perioperative adiponectin measurement can determine influences on the surgery of patients with multiple risk factor syndrome.
On the other hand, excessive operative invasion in the perioperative period sometimes results in patients' miserable outcomes. How to control the generation of excessive inflammatory cytokines at an early stage after surgery is important for preventing post operative complications, particularly post operative infection, from occurring. While a start has recently been made at introducing the immediate measurement of cytokines in blood in post operative management, it may be important for a method for control of cytokines to control only excessive reaction and maintain fundamental vital reaction itself. It is considered that the more detailed control of cytokines or custom-made treatment that takes into consideration difference in the reaction of each individual is required in the future. Thus, a more convenient and unerring stress marker has been demanded strongly.
Moreover, studies on endotoxin have been conducted actively in studies in the biological field and treatments and studies in the medical field of recent years. Attention has been given particularly to the activation of the immune system and the action of stimuli to cytokine production. These actions directly have strong involvement in diseases such as sepsis, liver failure, respiratory failure, DIC, and multiple organ failure (MOF), and there has been considerable interest on measures against them for a long time. Besides, it has recently been revealed that chronic endotoxin stimulation and cytokines including TNF-α induced by this stimulation are involved in the conditions of medical diseases including fatty liver and inflammatory bowel disease.
Although several techniques have been developed previously as techniques for neutralization or removal of endotoxin, their own problems have been pointed out. For example, globulin replacement therapy using anti-core polysaccharide LPS immunoglobulin falls short of preventive effect on infection and improvement in death rate attributed to shock. Monoclonal antibody therapy against lipid A also falls short of improvement in death rate attributed to shock. With progresses in antibacterial peptide (CAP18 peptide) therapy found from human neutrophils and further in the analysis of signals via an endotoxin-specific receptor (TLR), the possibility of anti-TLR antibodies as therapeutic drugs for endotoxin shock has been expected. However, none of them has led to clinical application. Moreover, a polymyxin B-adsorbed column, the only thing that is used clinically, employs extracorporeal circulation and as such, presents problems associated with cost efficiency, decreased blood platelets, and so on. Additionally, it was unclear whether the column improves cytokinemia, which essentially constitutes sepsis. As described above, the conventional techniques are not efficient as techniques for neutralization of endotoxin. Thus, the improvement and development thereof have been demanded strongly.